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Crohn’s disease is a chronic inflammatory disease of the gastrointestinal tract with relapsing and remitting episodes. Abscesses and fistulas are the most common presentations of anorectal Crohn’s disease. Antibiotics and surgical incision and drainage have been successful in treating perianal disease. We present here a 48-year-old woman with known case of Crohn’s disease who presented with massive swelling in the perianal region with severe throbbing pain and high-grade fever, 38.2°C; the surgeon noted a large perianal abscess near the anal verge with redness, hotness, and tenderness. One and a half months from perianal abscess surgery, culture sensitivity was done due to delayed wound healing and passage of greenish discharge, and it revealed highly resistant bacteria <i>Proteus mirabilis</i>, <i>Escherichia coli</i>, and Staphylococci. In conclusion, clinicians should be aware that abscess and fistula have a fair chance to develop in Crohn’s disease patients who are using immunomodulating and immunosuppressant therapy. In abscess and fistula cases, surgery should be determined as soon as possible, and close clinical monitoring should be performed. We recommend routine screening for enteric fistula and culture sensitivity of any discharge prior to the initiation of any antibiotic. Appropriate intervention should then be undertaken.

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Crohn's disease (CD) is an immune-mediated disorder of unknown etiology primarily affect the gastrointestinal tract with series of extra intestinal manifestations (EIM) and Extra intestinal complications (EIC) that affects different organs and systems. EIMs are capable of involving nearly every system in the body; some believe that IBD is a systemic disorder with predominantly bowel manifestations. EI complications are mainly caused by the disease itself that induce mal-absorption with consequent micronutrient deficiencies, osteoporosis, peripheral neuropathies, kidney stones, gallstones and IBD drug-related side effects. In Saudi Arabia, CD is reported frequently. In this review, we try to make stress on different previously reported frequencies of EIMs and EIC in patients with CD; from our point of view we make an overview on the ocular and pulmonary complications and manifestations that are related either to disease activity or an indication of the presence of CD. Scleritis, uveitis and dry eye syndrome in previous healthy subjects with intestinal manifestation help in early diagnosis of CD especially in unexpected ages of the diseases. Further work on pulmonary manifestations to make full explanation on whether pulmonary disease is secondary to the drugs or to the underlying disease process.